Apparatus for correcting curvatures of the spine



Sept- 30, 1958 J; c. RlssER 2,853,999

APPARATUS FOR CORRECTING CURVATURES OF' THE SPINE Filed Oct. 5. 1953 5 ShePZS-ShJ-,e1'l 1 sept- 30, 1958 J. c. RISSER 2,853,999

APPARATUS FOR CORRECTING CURVATURES OF THE SPINE Filed OCL. 5. 1953 3 Sheets-Sheet 2 [SZ/Z6@ J. C. RISSER Sept. 30, 1958 APPARATUS FOR CORRECTING CURVATURES OF' THE SPINE Filed Oct. 5. 1953 5 Sheets-Sheet 3 E@ zz.

APPARATUS FOR CORRECTING CURVATURES OF THE SPINE Joseph C. Risser, Pasadena, Calif.

Application October 5, 1953, Serial No. 384,017 14 claims. (ci. 12s-s4) This invention relates to a method and apparatus for correcting curvatures of the spine, and is particularly directed to an orthopedic table embodying novel means for supporting a patient in the correct physiological position during application of a plaster cast.

In correcting curvatures of the spine, both of the lateral and anteroposterior types, it has been conventional practice to apply plaster body casts of a type which make it necessary that the patient remain in a hospital or at least in bed with special nursing care. It is evident that such a method of curvature correction is extremely expensive and is uncomfortable to the patient, and furthermore is not physiological since the prolonged bed rest results in weakening of the muscles and in other adverse etects which it is greatly desired to avoid. Because of the expense and adverse physical elfects incident to the application and use of body casts of the type above indicated, attempts have been made to apply a body cast which would achieve the desired corrective result yet would not necessitate the continued hospitalization of the patient. Such attempts, have, however, been largely unsuccessful because of the great difficulty in supporting the patient in the proper physiological position during the application of the cast. In addition, it has not heretofore been appreciated what such a physiological position should be, particularly when the curvature to be corrected is of the anteroposterior type.

ln View of the above factors incident to the correction of spinal curvatures, it is an object of the present invention to provide an improved apparatus for supporting the patient in the correct position for cast application without interfering with the actual application or wrapping of the cast.

An aditional object is to provide a novel structure for applying localized pressure for the purpose of bending the spine of a patient in a direction opposite to the curvature to be corrected, the apparatus being adapted for use in performing such a function in connection with many types ot both lateral and anteroposterior curvatures.

An additional object is to provide an exertmely rigid, lightweight and easily manipulated localizer structure for applying localized pressure to the thoracic and lumbar regions of a patient to maintain him in the correct position for application of a plaster cast.

A further object is to provide an improved structure for supporting a patient in an anti-gravity position during application of a cast adapted to correct anteroposterior curvatures.

A still further object of the invention is to provide a method for applying a body cast of a type adapted to correct anteroposterior curvatures, the method being such that the patient will be ambulatory and will be held in the correct physiological position after the cast has become dry.

An additional object of the invention is to provide an. improved method for applying a body cast while main-V taining the thoracic or lumbar regions of the patient under localized pressure for the purpose of correcting spinal deformities.

The above and other objects and advantages of the invention will be more fully set forth in the following specication and claims considered in connection with the attached drawings to which they relate.

ln the drawings:

Figure 1 is a top plan view of an orthopedic table incorporating the apparatus for applying localized pressure to a patient in accordance with the present invention;

Figure 2 is a side elevational view of the showing of Figure l;

Figure 3 is an enlarged vertical sectional view along line 3-3 of Figure 2 and illustrating one of the ratchet mechanisms for tensioning a traction or support strap;

Figure 4 is a sectional View along the broken line 4--4 of Figure 3;

Figure 5 is a fragmentary vertical sectional View along line 5 5 of Figure 2 and illustrating the internal construction of one of the localizer devices;

Figure 6 is a sectional view along line 6-6 of Figure 5,` showing the details of the mounting means for the localizer;

Figure 7 is a view corresponding to Figure 6 but illustrating a form of localizer mounting means for use with a single supporting slide instead of the two supporting slides shown in Figures 1, 2 and 6;

Figure 8 illustrates a patient in position on the orthopedic table, after application of a portion of the body cast to the lower abdominal and pelvic regions;

Figure 9 is a View illustrating the application of the remainder of the body cast to the patient, there being localized pressure applied to the thorax while the head and hips are under traction;

Figure 10 is a side elevational view illustrating a patient in position on an apparatus constructed in accordance with a second embodiment of the invention, this apparatus being particularly adapted to aid in the practice of the method for correcting anteroposterior spinal curvatures;

Figure 1l illustrates the patient in the position assumed during and after application of the remainder or upper portion of the body cast, after application of the lower cast portion while the patient is in the Figure 10 position; and

Figure 12 is an exploded detail view of the means for supporting the upper back of the patient while he is in the position shown in Figure l1.

Referring to the drawings, and particularly to Figures 1 and 2, the frame and supporting components of the orthopedic table may be seen to comprise a pair of folding leg structures 15 and 16 adapted to support in generally horizontal position a main frame 17 which is provided at its ends with suitable ratchet frames 18 and 19. The leg structures 15 and 16, which may be of a rigid type instead of the folding type illustrated, each comprise a pair of generally rectangular leg frames one Iof which, numbered 21, is provided at its upper end with a cross-bar 22. The other leg frame, numbered 23, is pivotally connected to frame 21 at cross-bar 22 and is provided with upwardly extending ears 24 adapted to prevent the main frame 17 from sliding olf the cross-oar` 22 on which it is supported. With such a construction, the orthopedic table may be readily stored or transported merely by folding the leg structures 15 and 16 after removal of the frame 17. It is pointed out that the construction by which the main frame 17 may be lifted oi leg structures 15 and 16 is highly advantageous since it facilitates the removal of the patient to a bed or cart "after application of the cast. IThis acompljshedby lifting the frame and patient onto the bed or cart, and then manipulating the frame until it is clear of the patient and may be transported Iback to the supports and 16.

v The main frame 17 is generally rectangular in shape and preferably comprises two tubular `side bars 26 maintained in parallel spaced relation by the ratchet frames 18 and 19. The side bars 26, which may also be referred to as slides since they serve as supports for slidably mounted localizer devices to be described subsequently, are provided adjacent the head end of the frame, to the left in Figures l and 2, with inwardly extending axially spaced rod supports 27. The rod supports 27, which are also tubular and are welded or otherwise secured to the respective side bars, serve to support a strap-holding rod 2S inserted axially into both rod supports through suitable apertures in the walls of one of side bars 26. It will be observed upon reference to Figure l that the exposed portion of rod 28, between the adjacent ends `of rod supports 27, is adapted to be inserted through the looped end of a centrally disposed longitudinally extending support strap 29 yon which the patient is suspended during application of the cast. The support strap 29 may be demounted at any time during or after application of the Cast merely by withdrawing the rod 28 from its supports, a handle 31 being provided for this purpose at one end of the rod. The supports 27 serve, in addition to their function as the mounting means for the strap-holding rod 28, as the pivot supports for the structure of the second embodiment of the invention, Figures l0, 1l and 12.

Each of the ratchet frames 18 and 19 comprises two vertically extending end posts 32 respectively welded or otherwise secured at the ends of the side bars 26 of main frame 17. ln addition to the rigidly mounted end posts 32, the end frame 19 at the head of the main frame is provided with a rigid cross-bar 33 (Figure 10) welded between the head ends of side bars 26. As distinguished from the rigid cross-bar 33, the remaining three crossmembers lof ratchet frames 18 and 19 are not rigid but instead constitute ratchet rollers 34 adapted to roll and thus tighten the free ends of various straps such as support strap 29. In order to initially position and lock the associated strap end, each of the ratchet rollers 34 has secured thereon a longitudinally extending rod 35, there being a space between the rod 35 and roller to permit insertion of a strap end in any of a variety of centrally disposed or laterally oifset positions.

The lower roller 34 of ratchet frame 18 is adapted to tension the support strap 29, and the -upper ratchet rollers 34 of frames 18 and 19 are respectively adapted to ten sion traction straps 37 and 38 (Figure 9) which are, respectively, secured to the hips and head of the patient for purposesto be described subsequently. Each of the ratchet rollers 34 forms a component part of one of three identical ratchet assemblies only one of which, that associated with support strap 29 and mounted at the foot of the main frame beneath the ratchet for traction strap 37, will be described in detail.

Referring to Figures 3 and 4 which illustrate the details of the ratchet construction, the ratchet roller 34 is mounted on a journal rod 40 which extends axially therethrough and through a hub 41 at the juncture of side bar 26 and vertical post 32, there being a collar 42 provided on the end of journal rod 40 exteriorly adjacent hub 41 for the purpose of holding the journal rod in the proper axial position. It is to be understood that the other ends of ratchet roller 34 and journal rod 40, that is to say the opposite ends of these elements not shown in Figures 3 and 4, are journaled in the main frame 17 in any suitable manner. The construction and mounting of journal rod 40 and roller 34 is such that the latter may rotate freely relative to hub 41 except when restrained by an associated pawl and ratchet mechanism next to be described.

The pawl and ratchet mechanism comprises a" ratchet wheel 44 keyed on the reduced end of roller 34, a movable pawl 45 mounted in a pawl housing 46 which is journaled on roller 34 inwardly adjacent the ratchet wheel, and a stationary pawl 47 mounted in the end post 32. The housing 46 for movable pawl 45 has associated therewith a relatively long handle 48 which is made hollow 'for the purpose of receiving a compression spring 49, the latter being seated at its inner end on a plunger 51 and at its outer end on an adjustable stop 52. Plunger 51 is adapted to engage pawl 45 on one side of the pin 53 which pivotally mounts it in housing 46. The pawl portion on the 'other side of pin 53 is engaged by a compression spring 54 which acts against the spring 49 and is adapted to pivot the tooth-engaging end 56 of pawl 45 out of engagement with the teeth of ratchet wheel 44. With the described construction, the inward adjustment of stop 52, which is preferably of the threaded type, to compress spring 49 until it overpowers spring 54 will force pawl portion 56 into operative position in engagement wit-h the ratchet wheel teeth. On the other hand, outward adjustment of lstop 52 to reduce the pressure of spring 49 will permit spring 54 to pivot the pawl away from the ratchet teeth and into engagement with a stop 57. It follows that when stop 52 is threaded inwardly, clockwise pivotal movement of the handle 48 and the associated housing 46 will operate through pawl 45 to rotate ratchet wheel 44 and roller 34 clockwise, as viewed in Figure 4. When, however, the stop 52 is threaded outwardly to permit disengagement of the pawl from the ratchet wheel, rotation of the handle 48 and housing 46 will have no effect on the ratchet wheel 44 and roller 34 on which it is keyed.

The stationary pawl 47, which is pivoted on a horizontal pin 58 mounted in post 32, is adapted at its lower pointed end to. engage the ratchet wheel 44. At its upper end pawl 47 is engaged on one side by a compression spring 61 and on the other side by an adjustable stop screw 62, the relationship being such that spring 61 will pivot pawl 47 out of engagement with the ratchet wheel unless the pawl is restrained by the stop. When the stop 62 is adjusted inwardly to the position illustrated in Figure 4, at which pawl 47 is pivoted counterclockwise into engagement with ratchet wheel 44, the pawl operates as a holding element to restrain ratchet wheel 44 and the associate roller 34 against rotation during intervals of counterclockwise pivoting of ratchet handle 48. When, on the other hand, stop 62 is threaded outwardly or to the right in Figure 4, the spring 61 operates to pivot pawl 47 out of engagement with ratchet wheel 44 to permit free rotation of the latter in either direction.

In the operation of the pawl and ratchet assembly to tighten a strap such as support strap 29, the strap end is first inserted between rod 35 and the ratchet roller 34. Stops 62 and 52 are then adjusted inwardly until their associated pawls 47 and 45 are in operative engagement with the ratchet wheel 44. It is then merely necessary to pump the handle 48 upwardly and downwardly to eifect clockwise rotation of ratchet wheel 44 and roller 34 on each downward handle stroke, so that the strap 29 is wound on the roller 34 and thus tensioned. To unwind or loosen the strap 29, stops 62 and 52 are both adjusted outwardly lto permit pawls 47 and 45 to move out of engagement with ratchet wheel 44 and permit free rotation of the ratchet wheel and roller. The roller 34 then being freely rotatable, it is merely necessary to pull on strap 29 to unwind it.

According to `the present invention, means are provided to apply localized pressure to the thoracic, lumbar, or pelvic regions of the patient during application of traction to the head and hips and while the cast is being wrapped. These means, which may be referred to as localizers, are indicated generally at 64 and will be described in detail in connection with Figures 1, 2, and 5 through 9. The

localizers 64 are particularly adapted for use in correcting scoliosis or lateral curvatures of the spine, although they may be used in correcting anteroposterior curvatures. The latter type of curvature, however, may also be effectively corrected by applying body casts with the method and apparatus illustrated in Figures -12 of the drawings. Two localizers 64 are illustrated in Figures 1 and 2, but it is to be understood that either one or a number of localizers may be employed, depending upon the type of localized pressure which it is necessary to apply to correct a particular spinal deformity. The localizers being identical, only one will be described.

It is emphasized that because of the great variety in the types of spinal deformities and in the sizes of the patients, the points and directions of pressure application will differ with substantially each use of the orthopedic table. Accordingly, the localizer 64 may be shifted to a variety of locations longitudinally of main frame 17, and comprises a jack portion mounted in a shifting pivot relationship. The shifting pivot is such that the jack may be rotated in a plane transverse to main frame 17 and locked in any one of a number of rotated positions, with the pivot for the jack being shiftable along a semicircular cradle beneath the frame.

In order to accomplish the results above indicated, the localizer 64 is constructed with a cradle comprising two semi-circular slides or rails 65 mounted in parallel spaced relation in planes transverse to the axis of main frame 17. The slides 65, which are rigidly formed of metal and are rectangular in cross section, are associated at adjacent ends with latch or clamping means 66 best shown in Figure 5. The clamping means 66 may be of any suitable type but are illustrated as each comprising a semicylindrical upper portion 68 secured to the adjacent ends of slides 65 and adapted to slidably rest on the tubular side bars 26 of main frame 17. Upper portion 68 is pivotally associated at 69 with a clamp portion 70 the lower end of which is bifurcated to receive a clamp bolt 71 having a hand nut 72 at one end. The other end of bolt 71 is pivotally connected at 73 to a lug 74 on upper portion 68 generally beneath side bar 26, the relationship being such that upon loosening of hand nut 72 the clamp bolt 71 will be free to pivot downwardly and release clamp portion 70 for pivotal movement away from bar 26. The tightening of the hand nut 72, at each end of the cradle, when the parts are in the position illustrated in Figure 5, will effect locking of the localizer against longitudinal shifting along the main frame, While loosening of the hand nut to permit outward pivot of clamp portion 70 will make possible not only sliding of the localizer along the frame but also complete removal of the localizer if desired.

In addition to the rails or slides 65 and clamp portion 66, each localizer 64 comprises a jackscrew 76 which is mounted in a clamp 77 adapted to create a shifting pivot relationship between the jackscrew and rails. The jackscrew 76 is illustrated as comprising a relatively long cylindrical barrel 78 which is internally threaded to receive an externally threaded rod 79 having a crank 81 at its outer end and a relatively large diameter end cap 82 at its inner end. The threading on barrel 78 and rod 79 is preferably such that the rod may be adjusted a considerable distance without exposing the threads to view. Cap 82 is removably seated on the end of rod 79 so that it Will remain adjacent the patient and beneath the body cast when the rod is threaded outwardly to release the localized pressure as will be described.

Referring next to Figure 6, the shifting or sliding pivot clamp 77 comprises .a relatively large cylinder 83 which is transversely bored to adjustably receive the barrel 78 of jackscrew 76. Cylinder 83 is provided at each end with a Itrunnion 84 seated between a friction block 86 and one 87 of two cooperating clamp plates 87 and 88. It is to be noted that the clamp plates 87 and 88 lfor each of the trunnions 84 are respectively adjacent the trunnion and one of thesemicircular slides 65, and are shaped for surface engagement with theseelements. Plates 87 and 88 for each ltrunnion 84 are associated with each other by means of dowels 90 and a hand screw 91, the latter extending between the clamp plates outwardly of cylinder 83 so as not to interfere with its rotation.

In the operation of the clamp 77, the tightening of the hand screws 91 operates to draw clamp plates 87 and 88 toward each other to tightly lock the trunnions 84 against friction blocks 86, the latter being shaped for surface engagement with both the trunnions and slides. Rotation of the trunnions 84 and thus cylinder 83 containing jackscrew 76 is then eiectively prevented, and sliding of the clamps is also prevented by the friction contact between blocks 86 and slides r65. To shift the pivot point along slides 65, or to rotate the cylinder 83 on trunnions 84 for rotation of jackscrewl76 in a plane transverse to the main frame 17, it is merely necessary to loosen the hand nuts 91 and thus release the friction blocks 86 from tight clamping engagement with trunnions 84 on the one side and slides 65 on the other side.

For certain applications it may be desirable to construct the localizer with but a single semicircular slide or cradle as distinguished from the previously described pair of these elements.

Referring to Figure 7, a single-slide construction is illustrated which comprises a cylinder 93 which is transversely bored at one end to adjustably receive the barrel 78 of jackscrew 76, and is inserted at the other end in a unitary mounting block or casing 94. The cylinder 93 is freely rotatable relative to casing wall portions 95 and 96 which are curved correspondingly thereto, and is provided at its end with a trunnion 97 extending through another casingwall 98 and rotatably locked thereto by a nut 99. The casing walls 98 and 96 form with an end wall 101 a chamber adapted to receive a friction block 102 which is curved to seat over the adjacent surface of cylinder 93. Friction block 102 is also curved so that it is in surface engagement with the single semicircular slide or cradle member 103 of the localizer, the latter being loosely inserted through the edge walls, not shown, of casing 94. A hand screw 104 is threaded through wall 101 and into engagement with slide 103 on the opposite side thereo-f from friction block 102. The described construction permits free rotation of cylinder 93 and thus jackscrew 76, and also shifting of the clamp and jackscrew along slide 103, when the hand screw 104 is loosened. However, upon tightening of the hand screw the friction block 102 is forced into close engagement with both cylinder 93 and slide 103, so that rotation of the cylinder and shifting of the clamp are effectively prevented to lock the jack in the desired position.

The method of the first embodiment of the invention will be described with particular reference to Figures 8 and 9 and on the assumption that the illustrated apparatus is vemployed in performing the method, it being understood, however, that the apparatus may be somewhat modied if necessary or desirable.

Referring iirst to Figure 8, the support strap 29 is connected at one end to strap rod 28 (Figure 1) and at the other end to the lower ratchet roller 34 at the foot of the main frame. If desired, a cross-member 106 may be supported on frame sides 26 and beneath the strap 29 to provide a support point for it, the position of the cross-member 106 being varied in accordance with the size-of the patient `and the type of deformity to be corrected. The patient, having the usual body stocking applied, is then-lifted onto the frame and suspended on strap 29, the only other support points for the patient being in a second cross-member 107 for his head and the upper ratchet rollery 34 at the foot of frame 17 for his feet and lower legs. A portion of the body cast, indicated at 108, is then applied to the pelvic and lower abdominal regions by Wrapping plaster soaked cloth strips aroundboth ,the patient and thesupport strap 29. lt is -f' to be understood that before the cast portion 108 is applied, theratchet associatedwith strap 29., andwhich was completelyddescribed in connection with VFigures 3 and 4, is adjusted-to tension the strap until thepatient is in the desired position, illustrated as -a slightly jackknifed one.

Referring next to Figure 9, a head sling 109 is next applied to the head of the patient, and belt 11'0 is applied around the cast portion 108, the head sling and belt being respectively associated with the traction straps- 38 and 37. The clamp 77 (Figure 5) for localizer jack 76 is then adjusted, as previously indicated, until the jack is in position to apply the proper type of localized pressure to the patient. In the present illus-tration it is assumed that the patient has scoliosis, or lateral curvature of the spine, and that the curve is tow-ard the forward edge of the frame. It is thereforedesired to apply localized pressure in the opposite direction in order to correct the deformity, and in thepresent instance the point of pressure application is selected as being on the thorax relatively adjacent the spinal column.

The present method comprises the mounting of a relatively large pad 112, for example of felt, over the body stocking at the pressure point. In addition, a plaster pad, not shown, is mounted over the felt pad to provide localized support at the pressure point after removal of the jack. 'The jack is then adjusted until the end cap 82 is in pressure engagement with the pad 112 to apply the necessary localized pressure. Either prior or subsequent to localized application, or during its application, the ratchets for traction straps 37 and 38 are adjusted to apply traction to the patient. The operation of the traction sraps and the localizer is literally to bow the patient in a direction opposite to the direction of the lateral spinal curvature. After the patient is in the correct position, the remaining portion of the body cast, indicated at'113, is wrapped around the thoracic and upper abdominal regions and also around the support strap 29 and over the felt pad 112 and cap 82. The only break in the cast is therefore the very small point of which the main body of threaded rod 79 engages the end ca 82.

lfter the body cast has dried sufficiently to hold the patient in the proper physiological position, the ratchets for traction straps 38 and 37 are released through operation of the stops A52 and 62 shown in Figure 4, and the jack 76 is operated to draw the threaded rod 79 away from end cap 82 and -Eelt pad 112. The localizer 64 is then removed from frame 17 through operation of clamp means 66, and the frame with the patient on it is lifted from the Vsupports and 16 onto a bed or cart. The strap holding rod 28 is next withdrawn to release the support strap 29 and permit its removal from beneath the body cast. The cross-members 107 and 106 are then removed, and the frame and patient are manipulated to permit lifting of the frame 17 back onto its supports 15 and 16.

The end cap 82 of the localizer jack is then cut out from beneath the body cast by forming an aperture in the cast and of suiiicient size to receive the end cap only. Felt pad 112 and the'associated plaster pad are, however, left beneath the cast and operate to strengthen the portion of the cast from which the cap 82 was removed. The resulting cast is therefore a relatively strong one despite the extreme ease with which the patient was maintained in the proper position during its application.

For some types of cast application, the longitudinal body supporting strap 29 is removed after the lower cast portion 108 is applied and prior to the application of the upper cast portion 113, the patient then being supported on suitable transverse straps, not shown. This is because application of extreme localized pressure may, in some instances, tend to push the patient off the strap 29 and render his support less stable.

As previously indicated, the form of the invention embody-ing the localizers `64 may, if desired, be employed to correct anterposterior spinal curvatures as well as lateral curvatur'es. However, the method of positioning the patient for application of a cast adapted to correct an anteroposterior curvature, and which may be called the anti-gravity method, forms an important part of the present invention and is best performed while using the apparatus illustrated in Figures 10-12 of the drawings. The apparatus shown in Figures lil-l2, and which forms a second embodiment of the invention, comprises an adjustable table 116 which is suitably pivoted at its lower edge on rod supports `27 and pivotally connected adjacent its upper edge to an adjustment bar 117. The adjustment bar 117 is formed with a plurality of depending latch portions 118 adapted to selectively t over cross-bar 23 of frame 17 to adjust the angular position of table 116. It is pointed out that table 116 is a relatively large rectangular element and is adapted to support the head and shoulders of the patient at various positions, depending upon which of the notches between latch portions 118 is registered with rod 33.

The anti-gravity method for correcting an auteroposterior curvature of the spine may be briefly stated to comprise positioning the patient in a somewhat jackknifed position at which his thighs form an obtuse angle (approximately 135) with the lower back, while at the same time maintaining the head, neck and upper back of the patient in relatively straight alignment with the lower back. A portion ofthe cast is then applied to the pelvic and lower abdominal regions, after which the head, neck and upper back are bent backwardly prior to the application of the upper and remaining portion of the cast. The angle of `backward bending is such that the chest is more than normally protruded, and the upper back, at the shoulder blades, is in a substantial depression relative to a straight line between the lower back and the back of the neck and head. It has been discovered that when a cast is applied with the patient in the positions indicated, the amount of correction of the curvature is great yet the position of the patient `is extremely physiological and comfortable.

In carrying out the anti-gravity principle with the apparatus illustrated in Figuresy 10 and ll, the patient is first positioned on the frame 17 and supported by the strap 29 in such a way that the thighs are substantially jack-knifed relative to the trunk. No localizer is employed, the table 116 being instead utilized (Figure l0) to maintain the head, neck and upper back of the patient in alignment with the lower back as indicated above. The lower portion of the -body cast, indicated at 121, is then applied to the lower abdominal and pelvic regions by wrapping plaster soaked strips around the patient and the strap 29. Thereafter, .the table 116 is removed and the head of the patient permitted to rest on a cross-member 122 positioned on frame sides 26. The -upper back of the patient then rests on-rod supports 27 and rod 28 and bends therearound in such a way that the chest protrudes abnormally as indicated above. During this operation, the body supporting strap 29 is maintained in its initial position at which the thighs and back of the patient are in a jackkknifed or obtuse relationship. The upper portion 123 of the body cast is then applied, after which the entire cast is allowed to dry sufficiently to permit removal of the patientfrom the table in the manner indicated in connection with the previous embodiment.

It is a feature ofthe invention that the patient remains comfortable even when bent in the position illustrated in Figure ll. This is because the lback or shoulder blade region of the patient is not allowed to rest solely on rod 28 and rod supports 27 but instead is partially supported by weight plates 125 (Figure l2) which are suitably bent at 127 to tit over rod 28 and in accordance with the curvature of the back. The plates are adapted, respectively, to vfit into pockets 128 on the upper side of strap 29 adjacent the loop for the rod 28. The construction of the plates 125 is such that the weight of the patient is somewhat distributed, so that he remains relatively comfortable even when bent backwardly during the final portions of the operations. The rod 28 and weight plates 125 may be seen to constitute a form of localizer since they apply localized pressure to the back for the purpose of correcting its curvature.

While the particular apparatus herein shown and described in detail is fully capable of attaining the objects and providing the advantages hereinbefore stated, it is to be understood that it is merely illustrative of the presently preferred embodiments of the invention and that no limitations are intended to the details of construction or design herein shown other than as defined in the appended claims.

I claim:

l. Apparatus for supporting and positioning a patient during application of a body cast for the purpose of correcting a curvature of the spine, comprising a main horizontal frame having substantially parallel side bars held spaced apart 'by a plurality of cross bars, a curved support bar, means to suspend said support -bar from said side bars beneath and transversely of said main frame and adapted to permit sliding of said support bar longitudinally of said main frame, clamp means to lock said support bar to said frame at a selecte-d longitudinal position, shifting pivot means. mounted on said support bar for shifting therealong and for pivoting about an axis extending longitudinally of said main frame, and a jack mounted on said shifting pivot means for pivotal movement in a plane transverse to said main frame and about various axes along said support bar depending upon the position of said shifting pivot means, said jack being adapted to engage the back and sides of the torso of said patient and apply local pressure during application of the cast.

2. The invention as claimed in claim l, in which said shifting pivot means includes means to lock said jack against shifting and pivoting relative to said support bar.

3. T he invention as claimed in claim l, wherein said frame is provided with means to apply traction to said patient while local pressure is applied by said jack.

4. The invention as claimed in claim 3, wherein said traction means include pawl and ratchet mechanisms at the ends of said main frame, and traction straps adapted to be tensioned by said pawl and ratchet mechanisms.

5. An apparatus for supporting and positioning a patient during application of a body cast, comprising a horizontal main frame adapted to support said patient, an elongated support element suspended beneath said main frame and generally transversely thereof, said support element being mounted on said main frame for sliding movement therealong, jack means to apply localized pressure to said patient, and clamp means to adjustably mount said pressure applying means on said support element, said clamp means comprising rst and second relatively movable members mounted on opposite sides of said supportelement, a journal element journaled in said members, means to mount said pressure applying means on said journal element, and means to tighten said members to prevent movement thereof along said support element and to prevent pivoting of said journal element.

6. The invention as claimed in claim 5, in which said support element is a single arcuate bar the ends of which are mounted on said main frame.

7. The invention as claimed in claim 5, in which said support element is a pair of laterally spaced arcuate bars the ends of which are mounted on said main frame.

8. Apparatus for supporting and positioning a patient during application of a body cast, which comprises a horizontally disposed rigid frame having parallel side rails connected by cross rails, ratchet means mounted .at each end of said frame, a strap support element mounted at the mid-portion of said frame and extending between said rails, a body support strap connected at one end to said strap support element and at the other end to the ratchet means at one end of said frame, a removable backrest disposed above said frame with one edge pivotally supported on said strap support element, and adjustable means to vary the pivoted position of said backrestrrelative to said frame.

9. Apparatus for supporting and positioning a patient during application of a body cast, which comprises a horizontally disposed rigid frame having parallel side rails connected by cross rails, ratchet means mounted at each end of said frame, means operatively associated with said ratchet means for applying traction to said patient, a strap support element mounted at the midportion of said frame and extending between said rails, a body support strap connected at one end to said strap support element and at the other end to the ratchet means at one end of said frame, a curved support member mounted beneath said frame and seated slidably at its ends on said side rails, means to lock said support member at selected shifted positions on said side rails, shifting pivot means'mounted on said support member for 'shifting therealong and for pivoting about an axis which is longitudinal to said frame, a jackscrew mounted on said shifting pivot means for pivotal movement in a plane transverse to said frame and about various axes along said support member depending upon the position of said shifting pivot means, said jackscrew being adapted to engage selectively the back and sides of the torso of said patient and apply localized pressure thereto, and means to lock said shifting pivot means in various shifted and pivoted positions.

l0. An orthopedic apparatus comprising a lightweight generally rigid framework lying substantially in a common plane and readily movable between a litter and working support therefor, said framework having as its principal body-supporting member a ilexible strap extending centrally longitudinally thereof, means on said framework operable to support said strap with different lengths thereof exposed between its supported ends, said strap being adapted to support the body of a patient longitudinally of said strap in any selected extended position between straight and different angular positions while a cast is being applied to the patient, said strap being appreciably narrower than the patients body and conforming generally to the body curvature, said framework permitting relatively free access to the patient for the application of a cast thereto and including rigid supports extending above said frame-work at the opposite ends thereof, one of said supports being adapted to support a patients outstretched legs, and the other support being adapted to support strap means for connection with the upper extremities of a patient being tted with a body cast.

11. An orthopedic apparatus as defined in claim l0 wherein the opposite ends of said strap are anchored to longitudinally spaced portions of said framework, one of said anchorage portions including releasable ratchet means for tensioning and loosening said strap as required to support a patients body in a desired angular position while applying a cast thereto.

l2. An orthopedic apparatus as defined in claim 10 wherein said upwardly extending supports at the end portions of said framework include manually operable tensioning devices connectable with straps adapted to be attached to a patient, said tensioning devices being operable to hold portions of a patients body in traction While supported on said flexible strap.

13. An orthopedic apparatus as defined in claim l() including a thin rigid transverse support insertable between the upper side of said framework and the lower side of said strap at any desired point along the length of said framework, said support being clamped against '11 said framework by the weight of a patient on said strap, and the position of said transverse support lengthwise of the framework being effective in cooperation with tensile adjustments applied to said strap to control the angular support position of the patients body.

14. An orthpedic apparatus useful in supporting a patients body in a desired angular position while a body cast is being applied, said apparatus comprising a rigid rectangular frame having a flat strap considerably narrower than the body extending centrally lengthwise of said frame, means connecting the opposite ends of said strap to longitudinally spaced portions of said frame, means for lengthening said strap as necessary to support an outstretched patient thereon in a desired angular position while leaving the space between the patient and the sides of said frame substantially free for the appplication of a cast to the patient, and means for supporting limbs of the patient at an elevation above said frame including arcuate rigid means extending transversely beneath said frame with its opposite ends slidable along the longitudinal sides of said frame, and axially adjustable support means movable along said arcuate means and pivotable with respect thereto for providing support to a patients body from different positions as desired while applying a rigid body cast.

References Cited in the le of this patent UNITED STATES PATENTS 885,243 Haas Apr. 21, 1908 901,628 Langworthy Oct. 20, 1908 978,760 Langworthy Dec. 13, 1910 2,088,747 Kelley Aug. 3, 1937 2,150,314 Bell Mar. 14, 1939 2,396,640 Comper Mar. 19, 1946 2,658,507 Neufeld Nov. 10, 1953 2,683,455 Ulrich July 13, 1954 FOREIGN PATENTS 11,975 Switzerland Apr. l, 1896 152,892 Germany July 2, 1904 OTHER REFERENCES The Hawley-Scanlan Fracture, X-Ray and Orthopedic Table, a 1940 pamphlet of the Scanlan-Morris Co. of Madison, Wisconsin, pp. 16, 17. (Copy in Division 55.)

The American Journal of Orthopedic Surgery for 1903; pp. 204-5. (Copy in Division 55.)

Zeitschrift Fur Orthopadische Chirurgie for 1921, pages 39 and 44.

Zeitschrift Fur Orthopadie for 1950, pages 464-6. (Copies in Division 55.) 

